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25 Castelli MC, Friedman K, Sherry J et al (2011) Comparing the efficacy and tolerability of a new daily oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low cobalamin levels: a randomized, open-label, parallel-group study

Mechanistically, microbial dysbiosis exacerbates renal injury and fibrosis by increasing intestinal permeability, disrupting lipid metabolism, inducing ROS-mediated oxidative stress, and activating TLR4-mediated inflammatory responses ( Figure 4 ) [128]

While preclinical results show promising directions, the exact mechanisms, tissue-specific actions, and translational relevance remain incompletely defined